This invention relates generally to a cardiac catheter used for performing cardiovascular procedures on the heart. More particularly, this invention relates to an ablation catheter used predominantly for treating cardiac arrhythmias.
Radio frequency ablation (RFA) has become a common treatment for treating specific cardiac arrhythmias. Portions of the heart sometimes form alternative conduction pathways which interfere with the normal conduction of the electrical signals which regulate the beating of the heart thereby causing some cardiac arrhythmias to occur. In order to remove these alternative conduction pathways, the heart is first mapped through catheter mapping procedures in order to find where these alternative conduction pathways are located, and then RFA is used to prevent these areas of the heart from disrupting the normal conduction patterns of the heart.
RFA typically involves the use of a specialized ablation catheter which is positioned at the site of the alternative conduction pathway. Radio frequency (RF) waves are then typically delivered through the ablation catheter and onto the alternative conduction pathway. The radio frequency waves create heat at the site of the alternative conduction pathway creating a lesion which destroys the tissues forming the alternative conduction pathways.
Ablation catheters have been developed in order to deliver radio frequency waves at the site of the abnormal pathway. While some of these prior art ablation catheters are well suited for particular procedures, the ability of these prior art ablation catheters to perform a variety of procedures effectively have been limited due to a number structural constraints which are necessitated by the spatial and physiological requirements of the applications in which these ablation catheters are to be used. Size, flexibility, and maneuverability are common restraints which have previously prevented more effective ablation catheter designs.
One drawback to the prior art is their inability to make a variety of lesions. There are typically two types of lesions which are generated by ablation catheters. One type of lesion is a focal lesion where the RF wave is concentrated at a point. Typically, the prior art is limited to making focal lesions. A tip electrode carried on the distal tip of an ablation catheter is preferably used for making focal lesions. However, there are a variety of procedures in which linear lesions are preferred, requiring that the RF energy be delivered along a line. There are prior art ablation catheters which are capable of creating linear lesions; however, these prior art ablation catheters are not particularly suited for making focal lesions. A linear electrode is preferably utilized for making linear lesions. Although tip electrodes can also be used utilized for making linear lesions, the use of tip electrodes to make linear lesions can be significantly more difficult and time consuming.
The maneuverability of the prior art ablation catheters also limit their effectiveness. The ablation catheters are typically utilized within the interior chambers of the heart. The precise placement of the electrodes onto the site to which the RF waves are to be delivered and the sufficiency of the contact between an electrode and the site significantly impacts the effectiveness of the treatment. Linear electrodes, and especially longer linear electrodes, tend to be stiffer, making it more difficult for them to maneuver and to conform to the generally arcuate shape of the interior walls of the heart.
Another problem common amongst the prior art ablation catheters is the formation of coagulum around the electrode during ablation. The heat generated by the RFA sometimes causes the electrode to overheat causing the blood surrounding the electrode to coagulate on the electrode. As the coagulum collects on the electrode, the impedance between the electrode and the site to which the RF wave is applied increases thereby reducing the effectiveness of the electrode. As a result it is often necessary to stop the RFA in order to remove the coagulum from the electrode.
Accordingly, it is an object of this invention to provide an ablation catheter which is capable of generating both focal lesions and linear lesions while having the appropriate size, flexibility and maneuverability to enable it to be used effectively in a variety of RFA procedures.
Accordingly, it is also an object of this invention to provide for an ablation catheter with a linear electrode which is easily maneuverable and conforms readily to the arcuate shape of the interior of the heart while still having the appropriate size, flexibility and maneuverability to enable the ablation catheter to be used effectively in a variety of RFA procedures.
Accordingly, it is also a further object of this invention to provide an ablation catheter with a means for cooling the the electrode in order to reduce the rate at which the coagulum builds up on the surface of an electrode while still having the appropriate size, flexibility and maneuverability to enable it to be used effectively in most RFA procedures.
Other objects and advantages of the invention will become apparent as the description proceeds.
To achieve these objectives, and in accordance with the purposes of the present invention the following ablation catheter is presented. As will be described in greater detail hereinafter, the present invention provides the aforementioned and employs a number of novel features that render it highly advantageous over the prior art.
In accordance with an illustrative embodiment of the present invention, an ablation catheter is provided which comprises two major components, an articulating guiding catheter and an inner articulating catheter disposed therein. The guiding catheter is typically inserted into the vascular system and is guided and manipulated through the vascular system until it reaches the appropriate chamber of the heart. The inner catheter is disposed within the guiding catheter until a desired location in the heart is reached. At that point the inner catheter is then extended beyond the guiding catheter allowing the inner catheter to more precisely position itself onto a treatment site.
In an illustrative embodiment, the guiding catheter is comprised of a shaft section which is attached to an articulating section at its distal end and a first handle at its proximal end. The inner catheter is comprised of an elongated central shaft, an electrode assembly attached to the distal end of the central shaft, and a second handle attached to the proximal end of the central shaft.
In one embodiment, the electrode assembly is comprised of a flexible plastic catheter tube having an outer surface, a porous tip electrode, and at least one linear electrode carried on the outer surface of the catheter tube. The catheter tube is used to provide axial and radial stability to the electrode assembly and to provide a conduit to the electrode assembly. Fluid is distributed to the linear electrode and the porous tip electrode through a plurality of apertures extending from the inner surface of the catheter tube to the outer surface of the catheter tube.
The linear electrode is utilized in order to make linear lesions in the heart tissue. In one embodiment, the linear electrode is comprised of a tubular array of conductive metal strands carried on the outer surface of the catheter tube, the conductive strands extending along the catheter tube in a plurality of directions relative to the longitudinal axis of the catheter tube. In one embodiment, the tubular array of metal strands is a wound helical coil. In an alternate embodiment, the tubular array of metal strands is arranged in a braided construction. The porous tip electrode is located at the distal end of the electrode assembly. The tip electrode provides a means for creating lesions concentrated at particular points in the heart, otherwise called focal lesions.
Articulation of the electrode assembly is utilized in order to better align the linear electrode to the generally arcuate shape of the inner chambers of the heart. One means for articulating the electrode assembly is by extending a pull wire through the inner catheter and attaching it to the distal tip of the catheter tube. An alternate means for articulating the electrode assembly is achieved by running the pull wire through the inner catheter then having the wire run externally along the linear electrode and then finally attaching the pull wire to the distal tip of the electrode assembly. A second alternate means for articulating the electrode assembly is achieved through the use of a memory shaped tube which is thermally activated to conform to a predetermined shape upon reaching body temperature.
A more detailed explanation of the invention is provided in the following description and claims, and is illustrated in the accompanying drawings.